Saturday, April 12, 2008

The generally accepted figure is that American women attempt suicide about twice as often as men, but men actually commit suicide about four times as often as women. The disparity between male and female suicides is often explained in terms of psychological sex differences:

"Women process their experiences with friends. They discuss their feelings, seek feedback and take advice," Murphy says. "They are much more likely to tell a physician how they feel and cooperate in the prescribed treatment. As a result, women get better treatment for their depression."

And the usual story to explain the disparity between female suicide attempt and female suicide success goes something like this:

"An attempted suicide is not really an attempt at suicide in about 95 percent of cases. It is a different phenomenon. It's most often an effort to bring someone's attention, dramatically, to a problem that the individual feels needs to be solved. Suicide contains a solution in itself," he says.

In attempted suicide, both men and women tend to use methods that allow for second thoughts or rescue. Murphy says that when people intend to survive, they choose a slowly effective, or ineffective, means such as an overdose of sleeping pills. That contrasts to the all-or-nothing means like gunshots or hanging used by actual suicides.

Those are the numbers, and that is the traditional story: more men want to kill themselves, so they choose more lethal methods. More women are just being dramatic, so they choose pills.

Now consider the data from my previous post. When lethal methods are more known and available to women (physicians, chemists, veterinarians), they commit suicide more often (as do men, but not as much). And consider the most lethal, most frequently used method of all for suicides: the gunshot. Couldn't the fact that women successfully commit suicide less frequently than men be explained by the fact that women, by and large, own fewer guns?

How big is the disparity in gun ownership? Based on Gallup polls and census data, a man is about three times as likely as a woman to own a gun. Women are, of course, not prohibited from gun ownership as a group, but they are much less likely than men to be exposed to guns and learn how to use a gun. A factor of three difference in gun ownership may go a long way to explaining the disparity in suicide success compared to attempt, rendering the psychological explanation largely unnecessary. Of course, women who choose gunshot as a method of suicide frequently succeed; but we should not be so quick to claim that those who choose other methods that don't succeed just don't really want to die. Perhaps large numbers of them do not know enough about gun acquisition and use to feel comfortable choosing this method.

This brings up another issue, which is how we tell when a suicide or attempted suicide "really wanted" to commit suicide. Just because someone refuses to use a method available to him, should not in and of itself make us suspect that he "doesn't really want" to kill himself, any more than someone's rejection of a particularly nasty medical intervention should tell us that person "doesn't really want" to live. Suicides face different barriers, legal and practical, in achieving their ends. It's ridiculous to use willingness to overcome one particular society's set of barriers as the litmus test for whether someone wants to die enough. Many people do not wish to die by gunshot wound, but definitely wish to die, and would gladly die if better means were available - easier to accomplish, more comfortable, more certain, less ghastly for discoverers, and less likely to result in sequelae. Just because someone will not, or cannot, shoot himself in the head or slit his jugular vein should not entitle us to presume that he does not really want to die.

Edit: In Bangalore, India, more women commit suicide than men. The most common method is to use the extremely lethal industrial poisons available in India but not in the United States. This casts doubt on the theory that fewer women commit suicide because fewer women want to, and inclines one to think about the alternative hypothesis that women and men prefer different means, which are differentially available in the United States.

Cultural factors are, of course, not ruled out, but neither are they ruled out in the case of fewer female suicides in the United States.

14 comments:

I think that men are less considerate of the experience of discoverers, and possibly less concerned with how they will be regarded upon discovery (it may seem absurd to suggest that vanity should play a role, but quotidian concerns don't necessarily yield to the gravity of the act, as a passing glance at many suicide notes will reveal).

I've also encountered the view that gunshot suicides are especially hostile, since they are calculated to leave such a jarring mess to behold. To my mind, however, it seems less likely the case that male suicides are generally more hostile than that men are more dispositionally obtuse to begin with, or less empathic, than their female counterparts. Guns are reasonably expedient, but my hunch is that even women who own and use firearms regularly will prove less likely to use them for self-deliverence -- not because they're less serious, but because they're more considerate. Is there data?

Chip, I think that's most definitely worth considering. I'm not aware of any data on this specifically, but given the inherent ev-bio differences between men and women, I'd be more surprised if they DIDN'T have different method preferences than if they did.

A single-patient study (myself) reveals that females find it abhorrent to commit suicide by gunshot. Reasons: messiness and inflicting unnecessary suffering on discoverers, sure, but also pain, potential sequelae (getting hurt but not dying), and the fact that taking pills is a much more comfortable, natural act than pulling a trigger. I hadn't thought about the vanity angle, but you might be right. Irrational, but what about us humans isn't?

I don't think I'm a very accurate sample of females, though.

Anyway, this alternate explanation also casts doubt on the theory that fewer women kill themselves because fewer women want to. I've heard this taken so far (by a so-called feminist) as to claim that physician assisted suicide shouldn't be available AT ALL to terminally ill patients, because it would cause women to commit suicide when they didn't "really" want to (despite asking for PAS). Sigh.

Another possibility is that the disparity may hover around innate differences in motivation, which would also allow for the view that female suicides are no less serious. You might extrapolate from the insights posited in Roy Baumeister's article, "What's Good About Men?":

http://www.psy.fsu.edu/%7Ebaumeistertice/goodaboutmen.htm

Your friend's position re physician-assisted suicide is curious, given her ostensible feminist badge. Obviously, the same argument could be advanced regarding physician-assisted abortion. I have some residual problems with the body-choice argument where abortion is concerned since there is at least an arguable third party in the frame, but on matters like drug use and suicide, prohibiting autonomous choice reeks of paternalism.

It certainly reeks . . . haha. I wasn't talking about a friend - I was talking about Susan M. Wolf, in her article "Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia," in the book Feminism and Bioethics: Beyond Reproduction, which I found in Dena S. Davis' essay "Why Suicide is Like Contraception," linked from my blog.

I agree, it's completely paternalistic and not at all in line with feminist principles, an argument that Davis makes in detail. It's the same shaky logic that leads disability rights advocates to claim that physician-assisted suicide should be criminalized because disabled people would be vulnerable to it - basically saying, we can't trust disabled people/women to make up their minds themselves, so they shouldn't have the choice, so nobody should have the choice. Doesn't make a lot of sense to me. It points out that it matters a huge amount which option you choose as "default good." If abortion is "bad," we put the default on no-abortion, and abortions must be justified. If life is "good," we put the default on continued life, and the choice to die must be justified.

Wow, it might not have come out very clearly up there, but that seems important - the unexamined initial assessment of value. Thanks!

Chip - thanks for the link to the Baumeister article. He's running with the same ideas as Margot Wilson and Martin Daly in their scholarly ev-bio book Homicide (one of my favorite books of all time) - reproductive reality means that, while a few men are biologically very successful, plenty of men will not reproduce at all. This leads to risky behavior and the sad reality of "disposable" males, as Baumeister puts it. There are no disposable females, though, as females have a pretty fixed reproductive value. That seems promising as an explanation for differences in suicide intentions, not just completions. I hadn't thought to apply it to this in just this way.

Still, if women don't want to commit suicide and men do because men are "disposable" and likely to be in bad circumstances through risk-taking, that fails to explain the data on female doctors, vets, and chemists. Maybe male disposability explains the desperation necessary to actually pull the trigger of a gun to one's head, but not suicidal intent in the first place.

Then there's the relationship thing, which I find a little more dubious - women form close relationships and are more active in the sphere of close relationships, but men have more non-close relationships and are active in that sphere. I'm not sure how to apply that to suicide.

As far as I can tell, Braumeister has the facts wrong when it comes to violence within relationships, which is more male-perpetrated than female-perpetrated, at least the easy-to-measure kind like lethal violence (Daly and Wilson go into this in more detail) - I have no idea which is more common when it comes to face-slapping, as he puts it, though - it might well be women. If we conceded that women are just as violent as men within relationships, we'd expect just as many women as men, if not MORE women than men, to commit suicide by gunshot, perhaps to punish people in close relationships with them. But he seems to have a deep grasp of the underlying evbio principles, and a neat perspective.

Oh by the way I like your conception (on your site) of birth as an "aggression" - I find that really useful. I've been using words like "imposition" and "intrusion" and I feel like I'm dancing around some important concept and not quite lighting on it.

Of course, your point about the failure of Baumeister's motivation/risk/improvisation theory to account for why women in high status professions commit suicide at higher rates might be confounded if it turns out that women who pursue such traditionally male vocations are self-selected outliers. It could be that high achieving women are temperamentally more similar to males in the relevant respects and the higher suicide success rates are merely reflective of an underlying overlap. The fact that men in such occupations off themselves at relatively higher rates as well suggests to me that it might be more a matter of disposition and determination than professionally enabled access to more effective methods. I suspect it's a little bit of both, and neither explanation would seem to address the intentions of failed suicides, regardless of their gender. One way to look at it would be to see if a status-based continuum persists once professionally enabled access to means is held constant; i.e., if female vets are less or more likely than female doctors to kill themselves. Maybe you know the data well enough?

I think the relationship thing may fit with my point about women being more empathic and consequently more sensitive to the feelings of those left to discover the aftermath. Impersonal social relationships surely have value to men, but I think it is of a different quality than that which stems from the more intimate social bonds typically sought and cultivated by women. I imagine that more intimate relationships at once result from and foster a degree of empathy that makes the effect of one's suicide on others more resonant as a deterring factor. It seems to me that empirical suicidology could tease out what really informs such disparities. But it's a touchy subject, and a scientific swamp.

To my knowledge, the most credible proponent of the idea that men and women are coequals in terms of domestic violence is Richard Gelles:

http://www.sp2.upenn.edu/people/faculty/gelles/

There's no question that men win hands down in terms of lethality, but survey data seem to suggest that in other measures there is a surprising degree of parity of inter-gender violence that is not reflected in official crime statistics. It's one of those claims that I regard with curious skepticism, but it's always interesting when it comes up.

If life entails suffering and ends inevitably in death, then the conclusion that procreation is a form of aggression seems merely logical. You can sort of edge at this by looking at the legal literature on "wrongful life" claims. The stakes are more stark and the moral issues are expressed in terms of torts rather than violence, but such distinctions rely on legal dressing. As Jim puts it, you can save a life by not starting one. And the inverse conclusion follows, perforce.

Also, do women in other high status or traditionally male professions off themselves at higher rates, even when the work doesn't enable access to the tools and practical know-how? I'm thinking foremost of lawyers, engineers, accountants, psychologists, etc. I've been trolling around for good stats on suicide rates by profession and gender, but it's tough to find a reliable survey. I did bump into a couple of somewhat dated articles that discuss popular misconceptions and some problems with modeling suicide statistics in general.

See:

http://www.apa.org/monitor/jan01/suicide.html

And Cecil Adams has a good column at:

http://www.straightdope.com/columns/010420.html

He cites a 1990 study finding that female doctors commit suicide at a higher rate than male doctors.

Chip, good questions - one of these days I will dig up all of the profession/suicide studies and check them out. I did see a comprehensive study that found no elevated suicide risk for professionals in the finance field; this seems to indicate that it's access to means, not job stress, that leads to suicide. But I'd like to get ahold of nice data that could tell us whether women finance professionals kill themselves more than women in more traditional roles.

My main point with the post was how quick non-suicidal people are to point to explanations for suicidal ideation, and sex differences in true suicidal ideation, rather than to consider the (seemingly simpler) hypothesis that there might not be a difference in intention, just a difference in availability of means. That seems to be the glaring truth from the occupation studies: better means = more suicides. It's not as glaring obvious from the gender data - that's more mixed up.

On Baumeister and the thing with sexual symmetry in violence - here's a 1992 article in Social Problems debunking the symmetry hypothesis: The Myth of Symmetry in Marital Violence, by R.P. Dobash, R.E.Dobash, Wilson & Daly. Men are more violent in all areas, including relationships. Really not that shocking, from an evo-bio perspective. The absolute last person a female should be expected to aggress against is a (nearly guaranteed by sexual dimorphism) larger male.

Thanks for this, which I find mostly convincing. The most impressive evidence, to me, comes from the claim that CTS data fail to capture the "Cinderella Effect."

I still think the survey data may be capturing something real, even if "symmetry" as such is debunked. One problem is that the contextual triviality of most female on male violence is difficult to glean from a questionaire. Women may be more likely to slap and throw fists in a fit of pique, but I suspect the men on the receiving end seldom feel threatened in the same sense that would apply in a gender-reversed scenario. Dobash et al get this.

Whatever the verdict is, I have little patience for the mock outrage that some Men's Rights types express on the issue. It reminds me of the smarmy Sean Hannity style indignation that surfaces every time some suburban female teacher is said to have "raped" a fourteen-year-old male student. Politically interested stooges love to play the "double standard" card, but everyone knows it's bullshit.

I don’t see why using a gun to commit suicide is less considerate than other methods. For one you’ve already decided to die so it would seem concern for others feelings and well-being is not your first priority so I don’t see why this would be a factor in your decision-making (most likely the decision to end your life was in large part due to the extremely annoying and/or harmful behavior of others towards you). Secondly it’s absurd to feel more pain when the suicide used a more violent method to end his or her life: death is death and I for one wouldn’t really be interested in the way they died than in the knowledge if and how much they suffered. If a friend of mine would commit suicide this would be deplorable and sad of course but I’d much rather he put a bullet through his brain (if done correctly this ends life in milliseconds) than that he went out to hang himself but failed and ended up with severe braindamage or took so much of the wrong pills he didn’t die but instead ended up with a busted liver or other harrowing conditions.

That being said in most cases it would be cruel and unnecessary to blow out your brain in your home where a relative or loved-one would find you but this can easily be fixed: just take a stroll in the woods, maybe enjoy one last sundown coupled with a nice shot of whiskey, reminisce on the good things in your life (in your condition mostly just memories) and then when you’re ready pull the trigger. If and when they find you (if you have the cash you could go to some remote rainforest in latin-America, fat chance they’ll ever find your body there) your remains will be discovered by some random passer-by. Not fun for them of course but that’s life and we all know it sucks. At least they won’t have any emotional connection to you so there’s far less chance of trauma later on.

Apparantly a lot of women discard the gun-method because they are afraid of what they’ll look like when it’s done, to me this is complete idiocy coupled with extreme vanity. There is one simple truth to death: you will not be there to experience what comes after so why on earth (no pun intended) should you care wether or not you still look pretty when you’ve obviously had to deal with far worse crap than this. Of course it is quite understandable in a culture where women are conditioned to look pretty all the time (the Barbiedoll-phenomenom) and a lot of young women seem to make it their life’s mission to measure up to this ideal but it’s still hard to understand. Why would you care about what you look like, or broader whatever happens to your body after death, when the lights go out and you are no longer a person? Worms will consume your body sooner or later, regardless of how you died and the only way to prevent that is to ask for cremation (ending up as a pile of ashes, now that is a most aesthetically pleasing sight) or possible mummification. Vanitas vanitatum!

It seems I used the word understandable in two different meanings or contexts, since this could be construed as a contradiction allow me to elaborate on the difference: in the first instance I meant girls and women are conditioned to think and behave in a certain way (gender specific roles) and thus it is in this respect it’s understandable they value their appearance so much, even when deceased. The second instance is that intellectually it’s hard to comprehend this attitude since it’s clearly irrational and does not constitute a harm to the individual (the mutilated corpse is no longer owned or occupied by the deceased), thus I say it’s not logical to care and as far as I can see this attitude stems from pure vanity. If you truly want to die and it is in your best interest to disappear from the face of this earth then you should employ whatever means are available to you: in this the end justifies the means and if you are naïve enough to wait until suicide is finally made legal (with all that it implies like free access to lethal drugs) than you’ll more than likely die from old age and you won’t even be needing those pills anymore. I understand the reservations against the more violent methods and it’s a sign of intelligence to consider the risks involved but when you stay alive and suffer just because you can’t find the proper means or they are not available to you than it’s as much your fault as it is theirs.

Naturally you shouldn’t employ low-success methods that are likely to harm (in a lot of cases permanently) without actually causing death or use those methods that are generally effective but cause a lot of pain (setting yourself on fire is generally effective but it’s an awful, awful way to go) but if there are means available to you that ensure a relatively quick and reliable death (like using a gun) and you are absolutely sure this is the right thing to do and you have no other way of escaping your predicament by all means go for it. Yes, you’ll have to get over certain hang-ups and emotional reservations but if there is so much unpleasantness in your life that you’re seriously considering ending it than you should train and condition yourself to get over this fear: this is about your freedom and well-being after all. If we can’t or don’t wish to live but are afraid to die we are a sorry bunch indeed. Since death is one of the last real mysteries and people pretty generally are afraid of what they don’t know or comprehend (survival-mechanism) the natural reaction is to shy away from it but I really do think that sometimes death is preferable to life and in those cases we as free and intelligent beings should find the courage, wisdom and strength to die honourably and rid ourselves of an existence that has become a burden to us instead of being enslaved by it.

People in the US are actually quite lucky to have such liberal gun-laws, in a lot of countries it’s almost impossible to obtain a firearm unless you’re willing to wait a long time, take endless tests and are a licensed hunter or sport-shooter or happen to be or know a criminal. To me putting a gun to your head and pulling the trigger is one of the best and most reliable suicide-methods, especially when coupled with precautions in case the shot wasn’t that well-placed and didn’t cause death instantly. If you sit near a river or ledge and pull the trigger your weight will send you crashing down into the water or into the abyss: that way even if you didn’t die from the effects of the bullet itself the fall or the water will kill you and the beauty of it is that most likely you’ll be unconscious so you won’t even feel or experience it. There are far worse ways to go, trust me.

Over-thinking this way too much. The reason women don't actually commit suicide has nothing to do with them "not being as adept at killing themselves". Plenty of studies has established women have no problem with being aggressive and there is nothing to suggest a woman would be less lethal with a firearm.

Women commit suicide less because they don't intend to die in the first place. Its usually as a bid to get attention. Its as simple as that. Women are far less likely to commit to actions that place their lives in danger.